CalRecycleForm74(2023).pdf
PDF 849 KB Posted
- Attached to
- NR24-004 Seed Mix
- Solicitation number
- 0000032234
- Issued by
- Shasta County, California
About this file
The document is a Postconsumer Recycled-Content Certification form from the California Department of Resources Recycling and Recovery (CalRecycle) for the State Agency Buy Recycled Campaign (SABRC). The form requires contractors to certify the minimum percentage of postconsumer recycled-content material in products purchased by state agencies across 16 specified product categories, including paper products, plastic products, metal products, and more. The SABRC program mandates state agencies to report and verify the recycled-content of all purchases in these categories.
The document also includes details on the minimum postconsumer recycled-content requirements for each product category, ranging from 10% to 100% depending on the product type. Agencies must ensure purchases meet the applicable minimum standards or obtain a waiver. No other pricing, funding, or contracting details are provided in this certification form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DFW1080ext_(1).pdf | ||
| std1000_AI.pdf | ||
| std204.pdf | ||
| RFQ_NR24-004).docx | DOCX document | |
| DFW1082ext.pdf | ||
| Answers_to_questions_for_event_32234.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
STATE OF CALIFORNIA
Department of Resources Recycling and Recovery (CalRecycle) CalRecycle 74 (Revised 01/23)
Postconsumer Recycled-Content Certification
To be completed by the State agency
State Agency:
Purchasing Agent: PO #:
Phone: E-mail:
The State Agency Buy Recycled Campaign (SABRC) is a state mandated program that requires the reporting of all purchases made within 16 specified product categories. All state agencies are required to verify the recycled-content of all products purchased within each of these categories.
All businesses shall certify the minimum percentage in writing to the contracting officer or his or her representative, if not the exact percentage, of postconsumer recycled-content (PCRC) material in the products, materials, goods, or supplies offered or sold to the State regardless of whether the product meets the minimum content requirements specified in law (see reverse side). The certification shall be furnished under penalty of perjury. The certification shall be provided regardless of content, even if the product contains no recycled material. A State agency may waive the certification requirement if the percentage of postconsumer material in the products, materials, goods, or supplies can be verified in a written advertisement, including, but not limited to, a product label, a catalog, or a manufacturer or vendor Internet website.
Public Contract Code sections 12205(a)(1), (2), (3) and (b)(1), (2), and (3)
Contractor/Company Name_________________________________________________________________________________
Address_____________________________________________________________________Phone_____________________
Purchase Order #
RFQ #
RFP #
IFB #
Cal Card Order #
Item # Product or Services Description 1Percent Postconsumer Recycled- Content Material
2SABRC
Product Category Code
M eets SA
B R
C
Pursuant to Public Contract Code 12205(b)(1), I certify under penalty of perjury under the laws of the State of California that the above information is true and correct.
Print Name Signature Title Date
FOOTNOTES:
1. “Postconsumer recycled-content material” is defined as products that were bought, used, and recycled by consumers. For example, a newspaper that has been purchased, recycled, and used to make another product would be considered postconsumer material.
2. “Product category” refers to one of the categories listed below, into which the reportable purchase is best placed.
3. If the product does not belong in any of the product categories, enter “N/A.” Common “N/A” products include wood products, aggregate, concrete, and electronics such as computers, TV, software on a disk or CD, and telephones.
4. For reused or refurbished products, there is no minimum content requirement. (PCC 12209(l))
Purchase Order #
RFQ #
RFP #
IFB #
Cal Card Order #
Item #
Product or Services Description 1Percent
Postconsumer
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
RFP #
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
RFP #
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
RFP #
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
RFP #
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
RFP #
Recycled-
Content
Material
2SABRC
Product
Category
Code
M e e ts S
A B
California Department of Resources Recycling and Recovery (CalRecycle)
State Agency Buy Recycled Campaign (SABRC) - SABRC@CalRecycle.ca.gov
Code* Product Categories Product Subcategories Product Examples in each SABRC Category (PCC 12207 ) Examples include, but are not limited to, these individual products/materials.
Minimum Post-Consumer Content Requirement per Statute (PCC 12209 )
1A Paper Products Toilet Paper Toilet paper. 45 percent by fiber weight post-consumer fiber.
1B Paper Products Paper Towels Paper towels. 40 percent by fiber weight post-consumer fiber.
1C Paper Products Facial Tissues Facial tissue. 10 percent by fiber weight post-consumer fiber.
1D Paper Products Toilet Seat Covers Toilet seat covers. 20 percent by fiber weight post-consumer fiber.
1E Paper Products General Purpose Paper Wipes General purpose paper wipes. 40 percent by fiber weight post-consumer fiber.
1F Paper Products Food Serviceware Napkins, plates, bowls, food trays, takeout boxes, and placemats. 40 percent by fiber weight post-consumer fiber.
1G Paper Products Miscellaneous Paper Products Cartons, wrapping, packaging, file folders, hanging folders, building insulation and panels, corrugated boxes.
30 percent by fiber weight post-consumer fiber.
2 Printing and Writing Papers
Printing and Writing Papers Copy, xerographic, watermark, cotton fiber, offset, forms, computer printout paper, white wove envelopes, manila envelopes, book paper, note pads, writing tablets, newsprint, and other uncoated writing papers, posters, index cards, calendars, brochures, reports, magazines, and publications.
30 percent by fiber weight post-consumer fiber.
3A Soil Amendments and Toppings
Compost Soil amendments, soil conditioner for potting or plant mix, organic materials used for water conservation; organic materials such as biosolids or other comparable substitutes such as livestock, horse, or other animal manure, food residues or fish processing byproducts; mechanical breakdown of materials.
80 percent recovered material that would otherwise be normally disposed of in a landfill.
3B Soil Amendments and Toppings
Mulch Ground covers, weed suppressants. 80 percent recovered material that would otherwise be normally disposed of in a landfill.
4A Glass Products Glass Products Windows, test tubes, beakers, laboratory or hospital supplies, reflective beads, tiles, construction blocks, desktop accessories, flat glass sheets, loose- grain abrasives, deburring media, liquid filter media, and containers.
25 percent post-consumer, by weight.
4B Glass Products Fiberglass Fiberglass (insulation), 30 percent post-consumer, by weight.
5 Lubricating Oils Intended for use in a crankcase, transmission, engine, power steering, gearbox, differential chainsaw, transformer dielectric, fluid, cutting, hydraulic, industrial, or automobile, bus, truck, vessel, plane, train, heavy equipment, or machinery powered by an internal combustion engine.
70 percent re-refined base oil.
6 Plastic Products Printer or duplication cartridges, diskette, carpet, office products, plastic lumber, buckets, wastebaskets, containers, benches, tables, fencing, clothing, mats, packaging, signs, posts, binders, sheet, buckets, building products, garden hose, and trays.
20 percent postconsumer, by weight, is remanufactured or has a take back program.
7A Paint: Low-VOC: < 50 grams/liter Water-based paint, graffiti abatement, interior and exterior, and maintenance. 50 percent post-consumer paint.
7B Paint: Other VOC: > 50 grams/liter
Water-based paint, graffiti abatement, interior and exterior, and maintenance. 50 percent post-consumer paint.
8 Antifreeze Recycled antifreeze, and antifreeze containing a bittering agent or made from polypropylene or other similar non-toxic substance.
70 percent post-consumer material.
9 Tires (Retreaded tires)
Truck and bus tires, and those used on fleet vehicles (and passenger cars where available).
Retreaded: Must use an existing casing that has undergone retreading or recapping process in accordance with Public Resource Code (commencing with section 42400).
10 Tire- Derived Products
Flooring, mats, wheelchair ramps, playground surfacing, sports surfacing, parking bumpers, bullet traps, hoses, bumpers, truck bedliners, pads, walkways, tree ties, wheel chocks, rollers, traffic-related products, mudflaps, accessibility ramps, paths and sidewalks, animal care products, including, but not limited to, horse arena surfacing, stall mats, cow mats, and equestrian barn and breezeway flooring, artificial turf, landscaping and rubber mulch, outdoor surfacing, pavers and tiles, and posts.
50 percent recycled used tires.
11A Metal Products Metal Products Staplers, paper clips, steel furniture, desks, pedestals, scissors, jacks, rebar, pipe, plumbing fixtures, chairs, ladders, file cabinets, shelving, containers, lockers, sheet metal, girders, building and construction products, bridges, braces, nails, and screws.
10 percent post-consumer material, by weight.
11B Metal Products Vehicles Vehicles. 10 percent post-consumer material, by weight.
12 Building Finishes
Open Office Panel Systems
Open office panel systems. Middle range of state contracts.
13 Carpet Carpet Determined by DGS and Posted in SCM.
14A Erosion Control Products
Compost Filter Socks Compost filter sock. 100 percent post-consumer material.
14B Erosion Control Products
Compost Blanket Compost blanket, layer of compost protecting bare soil surfaces. 100 percent post-consumer material.
14C Erosion Control Products
Hydraulic Mulch Hydraulic mulch or erosion control process that uses fiber slurry and tackifier. 100 percent post-consumer material.
15A Textiles Textiles 0 percent post-consumer material.
15B Textiles General Textile Wipes General purpose wipes. 100 percent post-consumer material.
16A Pavement
Surfacing Rubberized Pavement Surfaces
Rubberized asphalt concrete and chip seal. 15 percent post-consumer material.
16B Pavement Surfacing
Recycled Asphalt Pavement
Recycled Asphalt Pavement 25 percent post-consumer material.
*It is each agency’s prerogative to assign internal codes/object codes for post-consumer recycled content products based on their internal paper or computer tracking systems.
For additional information, please visit www.CalRecycle.ca.gov/BuyRecycled/StateAgency/ mailto:SABRC@CalRecycle.ca.gov http://www.calrecycle.ca.gov/BuyRecycled/StateAgency/
Postconsumer Recycled-Content Certification
| State Agency: California Department of Fish & Wildlife |
| Purchasing Agent: |
| PO: |
| Phone: |
| Email: |
| ContractorCompany Name: |
| Address: |
| Phone_2: |
| Purchase Order RFQ RFP IFB Cal Card Order Row1: |
| Item Row1: |
| Product or Services DescriptionRow1: |
| 1Percent Postconsumer Recycled Content MaterialRow1: |
| 2SABRC Product Category CodeRow1: |
| Purchase Order RFQ RFP IFB Cal Card Order Row2: |
| Item Row2: |
| Product or Services DescriptionRow2: |
| 1Percent Postconsumer Recycled Content MaterialRow2: |
| 2SABRC Product Category CodeRow2: |
| Purchase Order RFQ RFP IFB Cal Card Order Row3: |
| Item Row3: |
| Product or Services DescriptionRow3: |
| 1Percent Postconsumer Recycled Content MaterialRow3: |
| 2SABRC Product Category CodeRow3: |
| Purchase Order RFQ RFP IFB Cal Card Order Row4: |
| Item Row4: |
| Product or Services DescriptionRow4: |
| 1Percent Postconsumer Recycled Content MaterialRow4: |
| 2SABRC Product Category CodeRow4: |
| Purchase Order RFQ RFP IFB Cal Card Order Row5: |
| Item Row5: |
| Product or Services DescriptionRow5: |
| 1Percent Postconsumer Recycled Content MaterialRow5: |
| 2SABRC Product Category CodeRow5: |
| Purchase Order RFQ RFP IFB Cal Card Order Row6: |
| Item Row6: |
| Product or Services DescriptionRow6: |
| 1Percent Postconsumer Recycled Content MaterialRow6: |
| 2SABRC Product Category CodeRow6: |
| Print Name: |
| Signature: |
| Title: |
| Date: |
| SABRC compliant1: Off |
| SABRC compliant3: Off |
| SABRC compliant2: Off |
| SABRC compliant4: Off |
| SABRC compliant5: Off |
| SABRC compliant6: Off |
| Code: |
| Product Categories: |
| Product Subcategories: |
| Product Examples in each SABRC Category PCC 12207 Examples include but are not limited to these individual productsmaterials: |
| Minimum PostConsumer Content Requirement per Statute PCC 12209: |
| 1A: |
| Paper Products: |
| Toilet Paper: |
| Toilet paper: |
| 45 percent by fiber weight postconsumer fiber: |
| 1B: |
| Paper Products_2: |
| Paper Towels: |
| Paper towels: |
| 40 percent by fiber weight postconsumer fiber: |
| 1C: |
| Paper Products_3: |
| Facial Tissues: |
| Facial tissue: |
| 10 percent by fiber weight postconsumer fiber: |
| 1D: |
| Paper Products_4: |
| Toilet Seat Covers: |
| Toilet seat covers: |
| 20 percent by fiber weight postconsumer fiber: |
| 1E: |
| Paper Products_5: |
| General Purpose Paper Wipes: |
| General purpose paper wipes: |
| 40 percent by fiber weight postconsumer fiber_2: |
| 1F: |
| Paper Products_6: |
| Food Serviceware: |
| Napkins plates bowls food trays takeout boxes and placemats: |
| 40 percent by fiber weight postconsumer fiber_3: |
| 1G: |
| Paper Products_7: |
| Miscellaneous Paper Products: |
| 30 percent by fiber weight postconsumer fiber: |
| 2: |
| Printing and Writing Papers: |
| Printing and Writing Papers_2: |
| 30 percent by fiber weight postconsumer fiber_2: |
| 3A: |
| Soil Amendments and Toppings: |
| Compost: |
| 80 percent recovered material that would otherwise be normally disposed of in a landfill: |
| 3B: |
| Mulch: |
| Ground covers weed suppressants: |
| 4A: |
| Glass Products: |
| Glass Products_2: |
| 25 percent postconsumer by weight: |
| 4B: |
| Glass Products_3: |
| Fiberglass insulation: |
| 30 percent postconsumer by weight: |
| 5: |
| FiberglassLubricating Oils: |
| 70 percent rerefined base oil: |
| 6: |
| FiberglassPlastic Products: |
| 20 percent postconsumer by weight: |
| 7A: |
| Paint: |
| LowVOC 50 gramsliter: |
| Waterbased paint graffiti abatement interior and exterior and maintenance: |
| 50 percent postconsumer paint: |
| 7B: |
| Paint_2: |
| Waterbased paint graffiti abatement interior and exterior and maintenance_2: |
| 50 percent postconsumer paint_2: |
| 8: |
| Other VOC 50 gramsliterAntifreeze: |
| 70 percent postconsumer material: |
| 9: |
| Other VOC 50 gramsliterTires Retreaded tires: |
| Truck and bus tires and those used on fleet vehicles and passenger cars where available: |
| 10: |
| Other VOC 50 gramsliterTireDerived Products: |
| 50 percent recycled used tires: |
| 11A: |
| Metal Products: |
| Metal Products_2: |
| 10 percent postconsumer material by weight: |
| 11B: |
| Metal Products_3: |
| Vehicles: |
| Vehicles_2: |
| 10 percent postconsumer material by weight_2: |
| 12: |
| Building Finishes: |
| Open office panel systems: |
| Middle range of state contracts: |
| 13: |
| Open Office Panel SystemsCarpet: |
| Carpet: |
| Determined by DGS and Posted in SCM: |
| 14A: |
| Erosion Control Products: |
| Compost Filter Socks: |
| Compost filter sock: |
| 100 percent postconsumer material: |
| 14B: |
| Erosion Control Products_2: |
| Compost Blanket: |
| Compost blanket layer of compost protecting bare soil surfaces: |
| 100 percent postconsumer material_2: |
| 14C: |
| Erosion Control Products_3: |
| Hydraulic Mulch: |
| 100 percent postconsumer material_3: |
| Textiles: |
| Hydraulic mulch or erosion control process that uses fiber slurry and tackifierTextiles: |
| 0 percent postconsumer material: |
| Textiles_2: |
| General purpose wipes: |
| 16A: |
| Pavement Surfacing: |
| Rubberized asphalt concrete and chip seal: |
| 15 percent postconsumer material: |
| 16B: |
| Pavement Surfacing_2: |
| Recycled Asphalt Pavement: |
| Recycled Asphalt Pavement_2: |
| 25 percent postconsumer material: |
| Text Field0: |
| Text Field1: |
| Text Field2: |
| Text Field3: |
| Text Field4: |
| Text Field5: |
| Text Field6: |
| Text Field7: |
| Text Field8: |
| Text Field9: |
| Text Field10: |
| Text Field11: � |
| Text Field12: |
| Text Field13: |
| Text Field14: |
| Text Field15: |
| Text Field16: |
| Text Field17: |
| Text Field18: |
| Text Field19: |
| Text Field20: |
| Text Field21: |
| Text Field22: |
| Text Field23: |
| Text Field24: |
| Text Field25: |
| Text Field26: |
| Text Field27: |
| Text Field28: |
| Text Field29: |
| Text Field30: |
| Text Field31: |
| Text Field32: |
| Text Field33: |
| Text Field34: |
| Text Field35: |
| Text Field36: |
| Text Field37: |
| Text Field38: |
| Text Field39: |
| Text Field40: |
| Text Field41: |
| Text Field42: |
| Text Field43: |
| Text Field44: |
| Text Field45: |
| Text Field46: |
| Text Field47: |
| Text Field48: |
| Text Field49: |
| Text Field50: |
| Text Field51: |
| Text Field52: |
| Text Field53: |
| Text Field54: |
| Text Field55: |
| Text Field56: |
| Text Field57: |
| Text Field58: |
| Text Field59: |
| Text Field60: |
| Text Field61: |
| Text Field62: |
| Text Field63: |
| Text Field64: |
| Text Field65: |
| Text Field66: |
| Text Field67: |
| Text Field68: |
| Text Field69: |
| Text Field70: |
| Text Field71: |
| Text Field72: |
| Text Field73: |
| Text Field74: |
| Text Field75: |
| Text Field76: |
| Text Field77: |
| Text Field78: |
| Text Field79: |
| Text Field80: |
| Text Field81: |
| Text Field82: |
| Text Field83: |
| Text Field84: |
| Text Field85: |
| Text Field86: |
| Text Field87: |
| Text Field88: |
| Text Field89: |
| Text Field90: |
| Text Field91: |
| Text Field92: |
| Text Field93: |
| Text Field94: |
| Text Field95: |
| Text Field96: |
| Text Field97: |
| Text Field98: |
| Text Field99: |
| Text Field100: |
| Text Field101: |
| Text Field102: |
| Text Field103: |
| Text Field104: |
| Text Field105: |
| Text Field106: |
| Text Field107: |
| Text Field108: |
| Text Field109: |
| Check Box0: Off |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box8: Off |
| Check Box9: Off |
| Check Box10: Off |
| Check Box11: Off |
| Check Box12: Off |
| Check Box13: Off |
| Check Box14: Off |
| Check Box15: Off |
| Check Box16: Off |
| Check Box17: Off |
| Check Box18: Off |
| Check Box19: Off |
| Check Box20: Off |
| Check Box21: Off |
| Text Field0_F0: |
| Text Field1_F1: |
| Text Field2_F2: |
| Text Field3_F3: |
| Text Field4_F4: |
| Text Field5_F5: |
| Text Field6_F6: |
| Text Field7_F7: |
| Text Field8_F8: |
| Text Field9_F9: |
| Text Field10_F10: |
| Text Field11_F11: � |
| Text Field12_F12: |
| Text Field13_F13: |
| Text Field14_F14: |
| Text Field15_F15: |
| Text Field16_F16: |
| Text Field17_F17: |
| Text Field18_F18: |
| Text Field19_F19: |
| Text Field20_F20: |
| Text Field21_F21: |
| Text Field22_F22: |
| Text Field23_F23: |
| Text Field24_F24: |
| Text Field25_F25: |
| Text Field26_F26: |
| Text Field27_F27: |
| Text Field28_F28: |
| Text Field29_F29: |
| Text Field30_F30: |
| Text Field31_F31: |
| Text Field32_F32: |
| Text Field33_F33: |
| Text Field34_F34: |
| Text Field35_F35: |
| Text Field36_F36: |
| Text Field37_F37: |
| Text Field38_F38: |
| Text Field39_F39: |
| Text Field40_F40: |
| Text Field41_F41: |
| Text Field42_F42: |
| Text Field43_F43: |
| Text Field44_F44: |
| Text Field45_F45: |
| Text Field46_F46: |
| Text Field47_F47: |
| Text Field48_F48: |
| Text Field49_F49: |
| Text Field50_F50: |
| Text Field51_F51: |
| Text Field52_F52: |
| Text Field53_F53: |
| Text Field54_F54: |
| Text Field55_F55: |
| Text Field56_F56: |
| Text Field57_F57: |
| Text Field58_F58: |
| Text Field59_F59: |
| Text Field60_F60: |
| Text Field61_F61: |
| Text Field62_F62: |
| Text Field63_F63: |
| Text Field64_F64: |
| Text Field65_F65: |
| Text Field66_F66: |
| Text Field67_F67: |
| Text Field68_F68: |
| Text Field69_F69: |
| Text Field70_F70: |
| Text Field71_F71: |
| Text Field72_F72: |
| Text Field73_F73: |
| Text Field74_F74: |
| Text Field75_F75: |
| Text Field76_F76: |
| Text Field77_F77: |
| Text Field78_F78: |
| Text Field79_F79: |
| Text Field80_F80: |
| Text Field81_F81: |
| Text Field82_F82: |
| Text Field83_F83: |
| Text Field84_F84: |
| Text Field85_F85: |
| Text Field86_F86: |
| Text Field87_F87: |
| Text Field88_F88: |
| Text Field89_F89: |
| Text Field90_F90: |
| Text Field91_F91: |
| Text Field92_F92: |
| Text Field93_F93: |
| Text Field94_F94: |
| Text Field95_F95: |
| Text Field96_F96: |
| Text Field97_F97: |
| Text Field98_F98: |
| Text Field99_F99: |
| Text Field100_F100: |
| Text Field101_F101: |
| Text Field102_F102: |
| Text Field103_F103: |
| Text Field104_F104: |
| Text Field105_F105: |
| Text Field106_F106: |
| Text Field107_F107: |
| Text Field108_F108: |
| Text Field109_F109: |
| Check Box0_F110: Off |
| Check Box1_F111: Off |
| Check Box2_F112: Off |
| Check Box3_F113: Off |
| Check Box4_F114: Off |
| Check Box5_F115: Off |
| Check Box6_F116: Off |
| Check Box7_F117: Off |
| Check Box8_F118: Off |
| Check Box9_F119: Off |
| Check Box10_F120: Off |
| Check Box11_F121: Off |
| Check Box12_F122: Off |
| Check Box13_F123: Off |
| Check Box14_F124: Off |
| Check Box15_F125: Off |
| Check Box16_F126: Off |
| Check Box17_F127: Off |
| Check Box18_F128: Off |
| Check Box19_F129: Off |
| Check Box20_F130: Off |
| Check Box21_F131: Off |
| Text Field0_F1: |
| Text Field1_F2: |
| Text Field2_F3: |
| Text Field3_F4: |
| Text Field4_F5: |
| Text Field5_F6: |
| Text Field6_F7: |
| Text Field7_F8: |
| Text Field8_F9: |
| Text Field9_F10: |
| Text Field10_F11: |
| Text Field11_F12: � |
| Text Field12_F13: |
| Text Field13_F14: |
| Text Field14_F15: |
| Text Field15_F16: |
| Text Field16_F17: |
| Text Field17_F18: |
| Text Field18_F19: |
| Text Field19_F20: |
| Text Field20_F21: |
| Text Field21_F22: |
| Text Field22_F23: |
| Text Field23_F24: |
| Text Field24_F25: |
| Text Field25_F26: |
| Text Field26_F27: |
| Text Field27_F28: |
| Text Field28_F29: |
| Text Field29_F30: |
| Text Field30_F31: |
| Text Field31_F32: |
| Text Field32_F33: |
| Text Field33_F34: |
| Text Field34_F35: |
| Text Field35_F36: |
| Text Field36_F37: |
| Text Field37_F38: |
| Text Field38_F39: |
| Text Field39_F40: |
| Text Field40_F41: |
| Text Field41_F42: |
| Text Field42_F43: |
| Text Field43_F44: |
| Text Field44_F45: |
| Text Field45_F46: |
| Text Field46_F47: |
| Text Field47_F48: |
| Text Field48_F49: |
| Text Field49_F50: |
| Text Field50_F51: |
| Text Field51_F52: |
| Text Field52_F53: |
| Text Field53_F54: |
| Text Field54_F55: |
| Text Field55_F56: |
| Text Field56_F57: |
| Text Field57_F58: |
| Text Field58_F59: |
| Text Field59_F60: |
| Text Field60_F61: |
| Text Field61_F62: |
| Text Field62_F63: |
| Text Field63_F64: |
| Text Field64_F65: |
| Text Field65_F66: |
| Text Field66_F67: |
| Text Field67_F68: |
| Text Field68_F69: |
| Text Field69_F70: |
| Text Field70_F71: |
| Text Field71_F72: |
| Text Field72_F73: |
| Text Field73_F74: |
| Text Field74_F75: |
| Text Field75_F76: |
| Text Field76_F77: |
| Text Field77_F78: |
| Text Field78_F79: |
| Text Field79_F80: |
| Text Field80_F81: |
| Text Field81_F82: |
| Text Field82_F83: |
| Text Field83_F84: |
| Text Field84_F85: |
| Text Field85_F86: |
| Text Field86_F87: |
| Text Field87_F88: |
| Text Field88_F89: |
| Text Field89_F90: |
| Text Field90_F91: |
| Text Field91_F92: |
| Text Field92_F93: |
| Text Field93_F94: |
| Text Field94_F95: |
| Text Field95_F96: |
| Text Field96_F97: |
| Text Field97_F98: |
| Text Field98_F99: |
| Text Field99_F100: |
| Text Field100_F101: |
| Text Field101_F102: |
| Text Field102_F103: |
| Text Field103_F104: |
| Text Field104_F105: |
| Text Field105_F106: |
| Text Field106_F107: |
| Text Field107_F108: |
| Text Field108_F109: |
| Text Field109_F110: |
| Check Box0_F111: Off |
| Check Box1_F112: Off |
| Check Box2_F113: Off |
| Check Box3_F114: Off |
| Check Box4_F115: Off |
| Check Box5_F116: Off |
| Check Box6_F117: Off |
| Check Box7_F118: Off |
| Check Box8_F119: Off |
| Check Box9_F120: Off |
| Check Box10_F121: Off |
| Check Box11_F122: Off |
| Check Box12_F123: Off |
| Check Box13_F124: Off |
| Check Box14_F125: Off |
| Check Box15_F126: Off |
| Check Box16_F127: Off |
| Check Box17_F128: Off |
| Check Box18_F129: Off |
| Check Box19_F130: Off |
| Check Box20_F131: Off |
| Check Box21_F132: Off |
| Text Field0_F2: |
| Text Field1_F3: |
| Text Field2_F4: |
| Text Field3_F5: |
| Text Field4_F6: |
| Text Field5_F7: |
| Text Field6_F8: |
| Text Field7_F9: |
| Text Field8_F10: |
| Text Field9_F11: |
| Text Field10_F12: |
| Text Field11_F13: � |
| Text Field12_F14: |
| Text Field13_F15: |
| Text Field14_F16: |
| Text Field15_F17: |
| Text Field16_F18: |
| Text Field17_F19: |
| Text Field18_F20: |
| Text Field19_F21: |
| Text Field20_F22: |
| Text Field21_F23: |
| Text Field22_F24: |
| Text Field23_F25: |
| Text Field24_F26: |
| Text Field25_F27: |
| Text Field26_F28: |
| Text Field27_F29: |
| Text Field28_F30: |
| Text Field29_F31: |
| Text Field30_F32: |
| Text Field31_F33: |
| Text Field32_F34: |
| Text Field33_F35: |
| Text Field34_F36: |
| Text Field35_F37: |
| Text Field36_F38: |
| Text Field37_F39: |
| Text Field38_F40: |
| Text Field39_F41: |
| Text Field40_F42: |
| Text Field41_F43: |
| Text Field42_F44: |
| Text Field43_F45: |
| Text Field44_F46: |
| Text Field45_F47: |
| Text Field46_F48: |
| Text Field47_F49: |
| Text Field48_F50: |
| Text Field49_F51: |
| Text Field50_F52: |
| Text Field51_F53: |
| Text Field52_F54: |
| Text Field53_F55: |
| Text Field54_F56: |
| Text Field55_F57: |
| Text Field56_F58: |
| Text Field57_F59: |
| Text Field58_F60: |
| Text Field59_F61: |
| Text Field60_F62: |
| Text Field61_F63: |
| Text Field62_F64: |
| Text Field63_F65: |
| Text Field64_F66: |
| Text Field65_F67: |
| Text Field66_F68: |
| Text Field67_F69: |
| Text Field68_F70: |
| Text Field69_F71: |
| Text Field70_F72: |
| Text Field71_F73: |
| Text Field72_F74: |
| Text Field73_F75: |
| Text Field74_F76: |
| Text Field75_F77: |
| Text Field76_F78: |
| Text Field77_F79: |
| Text Field78_F80: |
| Text Field79_F81: |
| Text Field80_F82: |
| Text Field81_F83: |
| Text Field82_F84: |
| Text Field83_F85: |
| Text Field84_F86: |
| Text Field85_F87: |
| Text Field86_F88: |
| Text Field87_F89: |
| Text Field88_F90: |
| Text Field89_F91: |
| Text Field90_F92: |
| Text Field91_F93: |
| Text Field92_F94: |
| Text Field93_F95: |
| Text Field94_F96: |
| Text Field95_F97: |
| Text Field96_F98: |
| Text Field97_F99: |
| Text Field98_F100: |
| Text Field99_F101: |
| Text Field100_F102: |
| Text Field101_F103: |
| Text Field102_F104: |
| Text Field103_F105: |
| Text Field104_F106: |
| Text Field105_F107: |
| Text Field106_F108: |
| Text Field107_F109: |
| Text Field108_F110: |
| Text Field109_F111: |
| Check Box0_F112: Off |
| Check Box1_F113: Off |
| Check Box2_F114: Off |
| Check Box3_F115: Off |
| Check Box4_F116: Off |
| Check Box5_F117: Off |
| Check Box6_F118: Off |
| Check Box7_F119: Off |
| Check Box8_F120: Off |
| Check Box9_F121: Off |
| Check Box10_F122: Off |
| Check Box11_F123: Off |
| Check Box12_F124: Off |
| Check Box13_F125: Off |
| Check Box14_F126: Off |
| Check Box15_F127: Off |
| Check Box16_F128: Off |
| Check Box17_F129: Off |
| Check Box18_F130: Off |
| Check Box19_F131: Off |
| Check Box20_F132: Off |
| Check Box21_F133: Off |
| Text Field0_F3: |
| Text Field1_F4: |
| Text Field2_F5: |
| Text Field3_F6: |
| Text Field4_F7: |
| Text Field5_F8: |
| Text Field6_F9: |
| Text Field7_F10: |
| Text Field8_F11: |
| Text Field9_F12: |
| Text Field10_F13: |
| Text Field11_F14: � |
| Text Field12_F15: |
| Text Field13_F16: |
| Text Field14_F17: |
| Text Field15_F18: |
| Text Field16_F19: |
| Text Field17_F20: |
| Text Field18_F21: |
| Text Field19_F22: |
| Text Field20_F23: |
| Text Field21_F24: |
| Text Field22_F25: |
| Text Field23_F26: |
| Text Field24_F27: |
| Text Field25_F28: |
| Text Field26_F29: |
| Text Field27_F30: |
| Text Field28_F31: |
| Text Field29_F32: |
| Text Field30_F33: |
| Text Field31_F34: |
| Text Field32_F35: |
| Text Field33_F36: |
| Text Field34_F37: |
| Text Field35_F38: |
| Text Field36_F39: |
| Text Field37_F40: |
| Text Field38_F41: |
| Text Field39_F42: |
| Text Field40_F43: |
| Text Field41_F44: |
| Text Field42_F45: |
| Text Field43_F46: |
| Text Field44_F47: |
| Text Field45_F48: |
| Text Field46_F49: |
| Text Field47_F50: |
| Text Field48_F51: |
| Text Field49_F52: |
| Text Field50_F53: |
| Text Field51_F54: |
| Text Field52_F55: |
| Text Field53_F56: |
| Text Field54_F57: |
| Text Field55_F58: |
| Text Field56_F59: |
| Text Field57_F60: |
| Text Field58_F61: |
| Text Field59_F62: |
| Text Field60_F63: |
| Text Field61_F64: |
| Text Field62_F65: |
| Text Field63_F66: |
| Text Field64_F67: |
| Text Field65_F68: |
| Text Field66_F69: |
| Text Field67_F70: |
| Text Field68_F71: |
| Text Field69_F72: |
| Text Field70_F73: |
| Text Field71_F74: |
| Text Field72_F75: |
| Text Field73_F76: |
| Text Field74_F77: |
| Text Field75_F78: |
| Text Field76_F79: |
| Text Field77_F80: |
| Text Field78_F81: |
| Text Field79_F82: |
| Text Field80_F83: |
| Text Field81_F84: |
| Text Field82_F85: |
| Text Field83_F86: |
| Text Field84_F87: |
| Text Field85_F88: |
| Text Field86_F89: |
| Text Field87_F90: |
| Text Field88_F91: |
| Text Field89_F92: |
| Text Field90_F93: |
| Text Field91_F94: |
| Text Field92_F95: |
| Text Field93_F96: |
| Text Field94_F97: |
| Text Field95_F98: |
| Text Field96_F99: |
| Text Field97_F100: |
| Text Field98_F101: |
| Text Field99_F102: |
| Text Field100_F103: |
| Text Field101_F104: |
| Text Field102_F105: |
| Text Field103_F106: |
| Text Field104_F107: |
| Text Field105_F108: |
| Text Field106_F109: |
| Text Field107_F110: |
| Text Field108_F111: |
| Text Field109_F112: |
| Check Box0_F113: Off |
| Check Box1_F114: Off |
| Check Box2_F115: Off |
| Check Box3_F116: Off |
| Check Box4_F117: Off |
| Check Box5_F118: Off |
| Check Box6_F119: Off |
| Check Box7_F120: Off |
| Check Box8_F121: Off |
| Check Box9_F122: Off |
| Check Box10_F123: Off |
| Check Box11_F124: Off |
| Check Box12_F125: Off |
| Check Box13_F126: Off |
| Check Box14_F127: Off |
| Check Box15_F128: Off |
| Check Box16_F129: Off |
| Check Box17_F130: Off |
| Check Box18_F131: Off |
| Check Box19_F132: Off |
| Check Box20_F133: Off |
| Check Box21_F134: Off |
| Text Field0_F4: |
| Text Field1_F5: |
| Text Field2_F6: |
| Text Field3_F7: |
| Text Field4_F8: |
| Text Field5_F9: |
| Text Field6_F10: |
| Text Field7_F11: |
| Text Field8_F12: |
| Text Field9_F13: |
| Text Field10_F14: |
| Text Field11_F15: � |
| Text Field12_F16: |
| Text Field13_F17: |
| Text Field14_F18: |
| Text Field15_F19: |
| Text Field16_F20: |
| Text Field17_F21: |
| Text Field18_F22: |
| Text Field19_F23: |
| Text Field20_F24: |
| Text Field21_F25: |
| Text Field22_F26: |
| Text Field23_F27: |
| Text Field24_F28: |
| Text Field25_F29: |
| Text Field26_F30: |
| Text Field27_F31: |
| Text Field28_F32: |
| Text Field29_F33: |
| Text Field30_F34: |
| Text Field31_F35: |
| Text Field32_F36: |
| Text Field33_F37: |
| Text Field34_F38: |
| Text Field35_F39: |
| Text Field36_F40: |
| Text Field37_F41: |
| Text Field38_F42: |
| Text Field39_F43: |
| Text Field40_F44: |
| Text Field41_F45: |
| Text Field42_F46: |
| Text Field43_F47: |
| Text Field44_F48: |
| Text Field45_F49: |
| Text Field46_F50: |
| Text Field47_F51: |
| Text Field48_F52: |
| Text Field49_F53: |
| Text Field50_F54: |
| Text Field51_F55: |
| Text Field52_F56: |
| Text Field53_F57: |
| Text Field54_F58: |
| Text Field55_F59: |
| Text Field56_F60: |
| Text Field57_F61: |
| Text Field58_F62: |
| Text Field59_F63: |
| Text Field60_F64: |
| Text Field61_F65: |
| Text Field62_F66: |
| Text Field63_F67: |
| Text Field64_F68: |
| Text Field65_F69: |
| Text Field66_F70: |
| Text Field67_F71: |
| Text Field68_F72: |
| Text Field69_F73: |
| Text Field70_F74: |
| Text Field71_F75: |
| Text Field72_F76: |
| Text Field73_F77: |
| Text Field74_F78: |
| Text Field75_F79: |
| Text Field76_F80: |
| Text Field77_F81: |
| Text Field78_F82: |
| Text Field79_F83: |
| Text Field80_F84: |
| Text Field81_F85: |
| Text Field82_F86: |
| Text Field83_F87: |
| Text Field84_F88: |
| Text Field85_F89: |
| Text Field86_F90: |
| Text Field87_F91: |
| Text Field88_F92: |
| Text Field89_F93: |
| Text Field90_F94: |
| Text Field91_F95: |
| Text Field92_F96: |
| Text Field93_F97: |
| Text Field94_F98: |
| Text Field95_F99: |
| Text Field96_F100: |
| Text Field97_F101: |
| Text Field98_F102: |
| Text Field99_F103: |
| Text Field100_F104: |
| Text Field101_F105: |
| Text Field102_F106: |
| Text Field103_F107: |
| Text Field104_F108: |
| Text Field105_F109: |
| Text Field106_F110: |
| Text Field107_F111: |
| Text Field108_F112: |
| Text Field109_F113: |
| Check Box0_F114: Off |
| Check Box1_F115: Off |
| Check Box2_F116: Off |
| Check Box3_F117: Off |
| Check Box4_F118: Off |
| Check Box5_F119: Off |
| Check Box6_F120: Off |
| Check Box7_F121: Off |
| Check Box8_F122: Off |
| Check Box9_F123: Off |
| Check Box10_F124: Off |
| Check Box11_F125: Off |
| Check Box12_F126: Off |
| Check Box13_F127: Off |
| Check Box14_F128: Off |
| Check Box15_F129: Off |
| Check Box16_F130: Off |
| Check Box17_F131: Off |
| Check Box18_F132: Off |
| Check Box19_F133: Off |
| Check Box20_F134: Off |
| Check Box21_F135: Off |
File details come from the government source that posted it. Updated .